Comparison of central venous oxygen saturation and mixed venous oxygen saturation during liver transplantation.

Central venous catheterisation is commonly performed during major surgery and intensive care, and it would be useful if central venous oxygen saturation could function as a surrogate for mixed venous oxygen saturation. We studied 50 patients undergoing living related liver transplantation. Blood samples were taken simultaneously from central venous and pulmonary artery catheters at nine time points during the pre-anhepatic, anhepatic, and postanhepatic phases. Four hundred and fifty sets of measurement were obtained. There was a good correlation between central venous oxygen saturation and mixed venous oxygen saturation. The mean (SD) difference (95% limit of agreement) was lowest at the first time point (1.06 (0.65)%, -1.94% to 2.7%) and then increased throughout the study but remained acceptable. The change in mixed venous oxygen and central venous oxygen saturations occurred mostly in parallel and as a result changes in mixed venous oxygen saturation were reflected adequately in the change in central venous oxygen saturation. The correlation between mixed venous oxygen saturation and cardiac output was poor.

The impact of maintaining normal serum albumin level following living related liver transplantation: does serum albumin level affect the course? A pilot study.

Hypoalbuminemia in patients with end-stage liver disease persists for weeks even after liver transplantation. Human albumin is widely used for volume replacement, to increase oncotic pressure, to improve organ function, and to promote wound healing. However, these practices are not evidence-based. We prospectively studied the clinical outcome of 40 patients following living related liver transplantation. Patients were randomized to an albumin group (n=20), where 20% human albumin was administered to maintain serum albumin level>or=3 g/dL, and a control group (n=20), where there was no correction for serum albumin. Hemodynamics and laboratory investigations, fluid administration, blood transfusion, and fluid balance were recorded during the first 5 days in the intensive care unit. Serum albumin level was significantly higher in the albumin group. Heart rate, blood pressure, central venous pressure, and cardiac output did not vary significantly between the groups. There was no significant difference in serum creatinine, creatinine clearance, bilirubin, ALT, AST, prothrombin time, and international normalized ratio between both groups. No significant difference between Tacrolimus level and dose required to maintain therapeutic concentration was noted between both groups. Postoperative course and complications did not vary significantly between both groups. In conclusion, postoperative albumin administration to a target serum albumin>or=3 g/dL does not have additional benefits for the postoperative course in patients scheduled for living related liver transplantation.

Synthesis and preliminary antimicrobial screening of new benzimidazole heterocycles.

A series of 2-methylbenzimidazole incorporated to different heterocycles through ethyl or carbamoylethyl groups at position 1 of benzimidazole were synthesized. Also 3-(2-methylbenzimidazol-1-yl)propanoic acid hydrazide incorporated with semicarbazides and thiosemicarbazides were prepared. Moreover, the triazole 5e underwent Michael addition and alkylation reaction. Some of the newly synthesized compounds showed considerable antimicrobial activity against gram positive, negative bacteria and yeast.

The epidemiology of schistosomiasis in Egypt: patterns of Schistosoma mansoni infection and morbidity in Kafer El-Sheikh.

This is a descriptive report of the Epidemiology 1, 2, 3 project in Egypt that made use of large probability sampling methods. These results focus on Schistosoma mansoni infection in the northern Nile Delta governorate of Kafr El Sheikh. A probability sample of 18,777 persons, representing the rural population of the entire governorate, was drawn. The sample was designed not to exclude villages based on location or presence of health care facilities and to include representation of the smaller ezbas or hamlets. The objective was to obtain detailed estimates on age- and sex-specific patterns of S. mansoni infection, and to provide a baseline for prospective studies. Stool specimens were examined by the Kato method. The estimated mean +/- SE prevalence of S. mansoni infection in the rural population was 39.3 +/- 3.3% in 44 villages and ezbas after weighing for the effects of the sample design. The estimated mean +/- SE geometric mean egg count per gram of stool (GMEC) was 72.9 +/- 7.3. Prevalence and GMEC varied considerably by village and ezba, with ezbas having a significantly higher prevalence. Villages and ezba-specific prevalence was strongly associated with GMEC (r2 = 0.61, P < 0.001). The prevalence of S. mansoni infection increased by age to 55.4 +/- 3.2% at age 16 without a significant change in the adult ages. There were no gender differences until age 6, after which males were consistently higher until middle age, when the differences converged. The age- and sex-specific pattern of GMEC varied widely; however, when the GMEC data were collapsed into 5-year age groups, the GMEC peaked at 81.5 +/- 12.1 eggs/g in the 10-14-year-old age group. These estimates provide the basis for evaluating control measures for reducing prevalence, intensity of infection, and transmission.

Study on rodents infestation in Alexandria and prevalence of Trichinella spiralis infection among them.

Rodents were monthly collected from the six districts of Alexandria all year round using live traps. The 1025 collected rodents were divided according to species, gender, age, and weight El-Amryia and El-Montaza were the most infested districts, while West, East, Middle and El-Gomrok Districts were the lowest infested ones. Rallus norvegicus was the highest abundant species in the city (41.9%) followed by R. rattus (37.2%), then Mus musculus (20.9%). There was no difference in abundance of rodents during summer compared with winter. Meanwhile, males represented 57.6% of the total collected rodents. Most of the collected rodents were < or = 2 months old (63.8%) or light weighed (61.6%) however, number of caught rodents became less and less as age or weight increased. Concerning El-Amryia and El-Montaza Districts where abattoirs are located, number of collected rodents from and around the abattoirs represented 70.4% of the total collected rodents compared with 29.6% collected from and around the houses of the same districts. The total prevalence of T. spiralis infection among collected rodents using digestion technique was 13.3%. El-Amryia, El-Montaza, West and El-Gomrok Districts were, in order, the only infected districts. Neither gender nor season of collection has influence on the prevalence of infection. The present study proved the role of abattoirs in the prevalence of T. spiralis infection. However, high prevalence of T. spiralis infection was detected among higher age or higher body weight groups of rodents. Sensitivity of the digestion diagnostic technique is proved compared with compressorium diagnostic technique. Nevertheless, diaphragm was the most sensitive site for detection of light infection in all studied rodents followed by thigh then tongue; expressed as number of larvae per gram tissue.

Human fascioliasis in an Egyptian village: prevalence and some epidemiological determinants.

A cross-sectional survey was conducted in Abis area, 15 kilometers south east of Alexandria city, to determine the prevalence of human fascioliasis and to study some of the epidemiological determinants which may affect the infection. A specially designed questionnaire interview was completed, and a total number of 3475 stool samples were examined. The results revealed a prevalence rate of fascioliasis of 11% in the studied area which was only second to S. mansoni. The prevalence of infection was significantly higher among females in general and specifically in the age group 5 to less than 15 years and 25 to less than 35 years. Family aggregation of fasciola infection was noticed among the studied group. The prevalence and also the risk of infection were significantly higher among children whose mothers were infected. They were, however, insignificantly higher among illiterate, single males, and low social class group. In addition, the prevalence and risk of infection were significantly higher among individuals obtaining their raw green leafy vegetables from multiple sources. From the results it was concluded that human fascioliasis is an important public health problem in Abis area with increased risk of spread of infection to Alexandria city through raw green leafy vegetables which represent the main source of infection.

Schistosoma mansoni in the Nile Delta, Egypt. A large scale epidemiological study in Kafr El Sheikh Governorate.

This is an early descriptive report of the 'Epidemiology 123' project in Egypt which makes use of large probability sampling methods. These results focus on Schistosoma mansoni infection in the northern Nile Delta Governorate of Kafr El Sheikh. A probability sample of 18,777 persons, representing the rural population of the entire Governorate, was drawn. The sample was designed not to exclude villages based on location or presence of health care facilities and to include representation of the smaller ezbas or hamlets. The objective was to obtain detailed estimates on age and sex specific patterns of S. mansoni infection, and to provide a baseline for prospective studies. Stool specimens were examined by the Kato method. The estimated prevalence of S. monsoni infection in the rural population was 39.3% (SE +/- 3.3) in 44 villages and ezbas after weighing for the effects of the sample design. The estimated geometric mean egg count per gram stool (GMEC) was 72.9 (SE +/- 7.3). Prevalence and GMEC varied considerably by village and ezba, with ezbas having a significantly higher prevalence. Villages and ezba specific prevalence was strongly associated with GMEC (r2 = 0.61, p < 0.001). The prevalence of S. mansoni infection increased by age to 55.4% (SE +/- 3.2) at age 16, without significant change in the adult ages. There was no gender difference until age six, after which males were consistently higher until middle age, when the differences converged. The age and sex specific pattern of GMEC varied widely, however, when the GMEC data were collapsed into five year age groups, GMEC peaked at 81.5 (SE / + - 12.1) epg in the 10 to 14 year age group. These estimates provide the basis for evaluating control measures for reducing prevalence, intensity of infection, and transmission.

Impact of population-based selective chemotherapy on prevalence and intensity of Schistosoma mansoni infections in the Nile Delta: Kafr El Sheikh.

The impact of selective treatment with praziquantel (40 mg/kg) on Schistosoma mansoni prevalence and intensity of infection in two annual follow-up examinations was measured. The target population was the entire rural area of the northern Nile Delta Governorate, Kafr El Sheikh, from which a probability sample was drawn. The sample included 44 villages and hamlets (ezba). Baseline prevalence was determined by the examination of stool by two Kato slides and all infected persons treated and reexamined one year later. Those found infected in the second round were treated and examined again one year later. The prevalence and geometric mean egg count declined across all ages in each follow-up (prevalence: 39.3% (SE +/- 3.3), 28.4% (SE +/- 2.6), and 22.4% (SE +/- 2.3), respectively; and GMEC: 72.9 (SE +/- 7.3), 52.5 (SE +/- 4.5), and 41.9 (SE +/- 2.4), respectively). Reduction in prevalence varied considerably by village and ezba and was strongly related to the proportion of the village or ezba population that was infected and treated (r2 = 0.29). This latter observation provides a rationale for the maximum application of chemotherapy in the endemic Nile Delta community.

The epidemiology of Schistosoma mansoni, hepatitis B and hepatitis C infection in Egypt.

There appears to be no epidemiological association between Schistosoma mansoni infection, the intensity of S. mansoni infection or S. mansoni infection complicated by schistosome hepatic fibrosis and the presence of antibody to hepatitis B virus core antigen (anti-HBc), hepatitis B surface antigen (HBsAg), antibody to hepatitis C virus (anti-HCV) or antibody to both agents. This was the main conclusion of a population-based study of an entire village in the northern Egyptian Nile Delta. All 1850 villagers were invited to participate and serological, parasitological and ultrasound examinations were completed on a high proportion of the total population (68% provided sera and higher percentages provided stool specimens and were subjected to ultrasound examinations). Testing with dual Kato slides indicated a high prevalence of S. mansoni infection in the village (49.1%), typical of the area. Hepatitis B virus (HBV) markers (presence of either anti-HBc and/or HBsAg) and anti-HCV were also found to be prevalent, present in 24% and 15.9% of the villagers, respectively. The age-adjusted odds ratios (OR) for infection with S. mansoni and HBV [1.13; 95% confidence interval (CI) = 0.87-1.48], HBsAg (1.11; CI = 0.47-2.58), or anti-HCV (1.02; CI = 0.7-1.37) were not significantly greater than unity. Similarly low and non-significant OR estimates were observed with those positive for both HBV and anti-HCV. No other outcome measures of S. mansoni infection (i.e. intensity of infection or ultrasonographically-determined schistosomal hepatic fibrosis) were found to be associated with HBV, HBsAg or anti-HCV.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum calcium, magnesium and phosphate in bilharzial hepatic fibrosis.

Serum calcium, magnesium, phosphate and albumin were estimated in 74 bilharzial patients and 14 normal individuals as control. A significant hypocalcaemia and hyperphosphataemia was found in bilharzial patients with liver fibrosis and ascites. The authors suggest that these changes may be due to hypoparathyroidism. Both ascitic and non ascitic patients showed hypomagnesaemia. This hypomagnesaemia was more obvious in the ascitic group. The hypomagnesaemia is probably due to excess aldosterone secretion in these patients, combined with hypoparathyroidism in the cirrhotic patients with ascites.

Urinary catecholamines in habitual smokers and non-smokers.

1. There is no significant difference between habitual-smokers and non-smokers in the incidence of cardiovascular hyperreactivity to smoking. 2. The resting level of urinary catecholamines is somewhat raised in the smoker group particularly in the hyperreactors. 3. Smoking 20 cigarettes caused a higher rise in urinary catecholamines in the hyperreactors of both groups than in the normoreactors. 4. Hypertensive patients exhibited the most exaggerated rise in both the cardiovascular response to smoking and in urinary catecholamines.

Synthesis and biological action of two glucocorticoid alkylating agents.

Two alkylating glucocorticoids have been synthesized in order to test the possibility of alkylating glucocorticoid receptors. The title compounds are 9alpha-fluoro-11beta,16alpha,17alpha,21-tetrahydroxypregna-1,4-diene-3,20-dione 21-[bis(2-chloroethyl)carbamate] 16,17-acetonide (I) and 11beta,17alpha,21-trihydroxypregn-4-ene-3,20-dione 21-[bis(2-chloroethyl)carbamate] (II), prepared from triamcinolone acetonide and cortisol, respectively, through the reaction of the C-21 hydroxyl group with phosgene and di-2-chloroethylamine in the presence of triethylamine. Both compounds are biologically active as inhibitors of the growth of cultured mouse fibroblasts and are able to compete for the specific binding of radiolabeled triamcinolone acetonide to the L929 cell receptor. The bis(2-chloroethyl)carbamate moiety is capable of reacting with nucleophilic groups as evidenced by the colorimetric reaction with 4-(p-nitrobenzyl)pyridine. Both the interaction with the receptor and inhibition of cell growth by these two glucocorticoids are reversible.

Effect of lynoestrenol and norgestrel on serum lipids in experimental atherosclerosis in rabbits.

PIP: The effect of lynestrenol and norgestrel on serum lipid levels was studied in rabbits with induced hyperlipemia. Lynestrenol and norgestre l were administered orally every day in doses of .33 and 1 mg/kg body weight, respectively. 20 days of treatment with lynestrenol significantly lowered levels of total cholesterol (p less than .02), cholesterol ester (p less than .5), phospholipids (p less than .05), and triglycerides (p less than .05). alpha- and beta-lipoproteins were not significantly changed (p more than .5). Similar effects were observed after cholesterol ether (p less than .5), phospholipids (p less than .02), alpha-lipoproteins (p less than .02), and beta-lipoproteins (p less than .05), though triglycerides were not significatnly changed (p more than .5). Both drugs increased athermatous patches on the aorta. The results demonstrate that lynestrenol and norgestrel both aggravate atherosclerosis in rabbits.^ieng